Severity of infection and seasonal variation of non-typhoid Salmonella occurrence in humans

Non-typhoid Salmonella infections may present as severe gastroenteritis necessitating hospitalization and some patients become septic with bacteraemia. We hypothesized that the seasonal variation of non-typhoid Salmonella occurrence in humans diminishes with increased severity of infection. We examined the seasonal variation of non-typhoid Salmonella infections in three patient groups with differing severity of infection: outpatients treated for gastroenteritis (n=1490); in-patients treated for gastroenteritis (n=492); and in-patients treated for bacteraemia (n=113). The study was population-based and included all non-typhoid Salmonella patients in a Danish county from 1994 to 2003. A periodic regression model was used to compute the peak-to-trough ratio for the three patient groups. The peak-to-trough ratios were 4-3 [95 confidence interval (CI) 3 center dot 6-5 center dot 0] for outpatients with gastroenteritis, 3 center dot 2 (95% Cl 2 center dot 4-4 center dot 2) for in-patients with gastroenteritis, and 1 center dot 6 (95% CI 1 center dot 0-2 center dot 8) for in-patients with bacteraemia. We conclude that the role of seasonal variation diminishes with increased severity of non-typhoid Salmonella infection.